Muscle tears around the shoulder are common problems. This muscle group, called the rotator cuff, can tear after a severe fall or trauma in young patients, and due to wear/tear in older patients.
WHAT ARE THE SYMPTOMS OF MUSCLE AROUND THE SHOULDER (ROTATOR CUFF) TEARS? ?
The most important symptom of muscle tears around the shoulder is pain. The pain usually starts from the outer side of the shoulder and continues to the middle of the arm, and usually occurs when lifting your arm up. In the early stages, there is no obvious pain when the arm is next to the body. Pain when trying to pick up a box from a high shelf is typical. Another finding is the loss of strength and weakness that occurs when lifting the arm sideways and up. This loss of strength may be due to pain or it may be due to the muscle not being able to perform its function. In long-term and untreated muscle tears, arthrosis (calcification) may occur due to wear and tear in the shoulder joint. In such a case, there may be pain at rest and limitations in shoulder range of motion may also occur. Rotator cuff tears can be full thickness or partial, both have similar findings, but loss of strength is more evident in full thickness tears.
HOW ARE DIAGNOSIS OF SHOULDER AROUND MUSCLE (ROTATOR Cuff) TEARS?
Diagnosis of shoulder circumferential muscle (Rotator cuff) tears begins with a careful examination. After listening to the story of the disease, your doctor examines you by paying attention to findings such as shoulder range of motion, muscle strength, and special compression tests. With x-rays, the condition of the bone structure, areas of intramuscular lime accumulation (calcific tendinitis) and the presence of wear/wear in the shoulder joint are investigated. The most valuable method in the diagnosis of muscle tears around the shoulder is magnetic resonance imaging (MRI). With MRI, the location and size of the tear, fatty degenerations in the muscle due to disuse, and wear of the joint cartilage are evaluated in detail. The examination may be repeated after a local anesthetic is injected into your shoulder to evaluate your muscle strength. In experienced hands, ultrasound helps diagnosis. The final stage in the evaluation of the rotator cuff is arthroscopic examination. Both the lower and upper sides of the muscle are evaluated arthroscopically.
HOW IS THE TREATMENT OF MUSCLE AROUND THE SHOULDER (ROTATOR CUFF) TEARS?
In patients over 65 years of age, in patients with partial muscle tears, if muscle strength and shoulder range of motion are good, the first treatment is usually surgical. It is not. Treatment begins with anti-inflammatory medications, appropriate exercises and physical therapy methods. If your doctor deems it necessary, single-dose cortisone injections into the shoulder can relieve pain. Surgical treatment is performed in patients whose pain continues despite medication, cortisone injection and physical therapy. Arthroscopic treatment is the gold standard for partial muscle tears that do not respond to drug treatment. Depending on the type of tear, only the frayed area can be cleaned and the bone protrusions that cause compression can be shaved, or the tear can be made full-thickness and repaired.
In patients with loss of strength in the arm, young people and their arm can be repaired. Surgical treatment is required in individuals who actively use it and in patients with full-thickness muscle tears. Especially full-thickness tears larger than 1.5 cm have a very high risk of progression if they are not repaired surgically. Surgical treatment can be performed by arthroscopic or open methods, depending on the location, size and repairability of the tear. In cases of tears that cannot be repaired, muscle transplants (tendon transfer) taken from another region can be performed in young patients. Shoulder prosthesis surgeries are on the agenda in patients of advanced age and with advanced calcification (arthrosis) in the shoulder joint.
HOW IS ARTHROSCOPIC ROTATOR CUFF REPAIR DONE?
Arthroscopic rotator cuff The repair is performed under operating room conditions and anesthesia. Small 1cm long incisions are made at different points around the shoulder. The shoulder joint and muscle tear area are evaluated with camera systems placed through these incisions. After other problems that may accompany the joint are corrected, the muscle tear is repaired and attached to the area where it has been separated from the bone with titanium implants called suture anchors. Hospital stay is 1 night. In some cases, it may be necessary to terminate arthroscopic surgery and continue the procedure with a small incision called mini-open surgery.
HOW IS THE POST-SURGERY RECOVERY?
Rupture after arthroscopic rotator cuff repair. Depending on the size of the fracture and the strength of the repair, it is necessary to use an arm sling for 3-6 weeks. Passive movements (done with the help of someone else) can be started after 2-3 weeks, as deemed appropriate by your doctor. Active movements and strength exercises will begin after the 6th week. It takes up to 6 months for the shoulder to take its final shape. It is possible to drive after the sixth week. Returning to strenuous sports is not before six months.
CAN THE ROTATOR CUFF REAR AGAIN AFTER REPAIR?
Inadequate tissue quality of the repaired muscle, advanced age of the patient, The muscle may tear again in some patients, depending on risk factors such as improper rehabilitation, re-traumatization, excessive fatty degeneration in the muscle, smoking, and the size of the tear being too large at the time of initial repair. This reoccurring tear is often smaller than the first tear and does not cause serious symptoms in half of the patients. There is no need for another surgical treatment unless it causes pain and loss of strength again.
ARE THERE ANY OTHER TREATMENT METHODS FOR ROTATOR CUFF TEARS THAT CANNOT BE REPAIRED?
In some cases, arthroscopic surgery is required. During the examination, it may be decided that rotator cuff repair is not possible. In this case, your surgeon may perform a partial repair or shave the bone protrusions that caused the tear. In young patients, if there is no damage to the shoulder joint cartilage, transplantation of other muscles around the shoulder can be performed for irreparable rotator cuff tears. This procedure requires open surgery. If the shoulder joint cartilage is severely worn in older patients, reverse shoulder prosthesis can be performed in cases of irreparable tears.
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